Interventions for Children with FASD
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RUNNING HEAD: Interventions for Children with FASD
Interventions for Children with FASD
Darrell Peterson
EPSY 8993
Spring Semester 2008
Leslie Craig-Unkefer, Ed. D.
February 16, 2016
Interventions for Children with FASD
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Defining the Population .................................................................................................. 3
Learning Characteristics of FASD .............................................................................. 3
Definition of the targeted learning deficit ....................................................................... 5
General strategies for intervention design in this area .................................................... 6
Advantages of computer-based interventions for children with FASD ...................... 6
Technology based interventions for students with Autism ......................................... 8
Framework and strategies for intervention design .................................................... 11
Summary and conclusions ............................................................................................ 14
References ..................................................................................................................... 15
Interventions for Children with FASD
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The purpose of this paper is to examine specific areas of learning deficits in children with
FASD in order to design an intervention for these children. Additionally, a framework,
guidelines, and strategies will also be developed in order to guide the development of
interventions.
Defining the Population
Children who are prenatally exposed to alcohol suffer from a variety of conditions,
including Fetal Alcohol Syndrome (FAS), Fetal Alcohol Effects (FAE), Alcohol Related
Neurological Deficits (ARND), and Alcohol Related Birth Defects (ARBD). Recently, these
conditions have been joined under the umbrella term Fetal Alcohol Spectrum Disorders (FASD).
It is important to keep in mind that the reasons behind these various diagnoses have as much to
do with physical abnormalities, such as facial dysmorphology, and evidence of maternal alcohol
consumption during pregnancy, as they do with cognitive functioning. For example, the primary
differentiator between FAS and FAE involves facial dysmorphology (small orbital sockets and
eyes, flat filtrum, thin upper lip, etc.). Streissguth (1997) notes that children with FAS and FAE
suffer from similar cognitive deficits. Since it is these deficits that most concern us here, I will
use the term FASD when referring to this population throughout this paper.
Learning Characteristics of FASD
When discussing the characteristics of this population, it is important to keep in mind the
varying degrees to which each of the characteristics enumerated below is present in an
individual. Because the amount of alcohol consumed during pregnancy, and the developmental
period during which it was consumed dictate the severity of the damage and the area of the brain
where the damage occurred, characteristics will vary from individual to individual. However,
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recent research has identified particular areas of the brain that are more susceptible to the
teratogenic effects of alcohol than others. Damage to these areas tend to lead to specific
cognitive deficits.
One final consideration when discussing the characteristics of this population lies
in the area of social-emotional characteristics and mental health. Children (and adults) with
FASD have much higher incidence of mental health issues than the general population.
Streissguth suggests that many of these issues are due, in part, to the invisibility of their
disability. She suggest categorizing issues into primary disabilities, which are due to the
teratogenic effects of alcohol, and secondary disabilities, which are due in large part to the
invisibility of their disease and the failure of parents, educators, and psychologists to effectively
deal with the primary disabilities. This classification is, I think, most helpful when discussing
strategies and interventions that are appropriate for this population.
Children with FASD suffer from a variety of learning problems, including below
normal IQ (although this is not the norm for the population), impaired spatial memory,
impairments of cognitive estimation, impairments in executive function, attention deficits,
sensory integration issues, processing speed deficits, decreased verbal and nonverbal fluency,
impaired auditory memory for verbal recall, poor impulse control, poor judgment, difficulty with
transitions, attention deficits, and poor habituation skills (Peterson, 2007).
Despite these difficulties, children with FASD also have many strengths which can be
leveraged to help them overcome their deficits. Malbin (1999) observes that children with FASD
frequently succeed in structured environments and enjoy repetitive work. She also outlines some
areas where children with FASD excel, including strong verbal fluency and positive use of visual
language techniques. They also do well with tasks involving a hands-on approach and exhibit a
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high energy level that enables them to be involved in many activities. Malbin (1999) and
Henrickson (2004) also observed strong visual memories in these children. In low stress
conditions, children with FASD may also show positive personality characteristics such as
persistence and commitment (Kleinfeld, 2000; Kleinfeld & Wescott, 1993; Malbin, 1999). These
strengths are important to keep in mind when learning to work with children who have FASD.
Definition of the targeted learning deficit
The available literature clearly supports targeting the development of social skills as an
important priority when working with children with FASD. As Root (1997) points out, “The first
and most important goal in working with Fetal Alcohol children is social. Until children
diagnosed with Fetal Alcohol Syndrome (FAS) or Fetal Alcohol Effect have some consistent,
practical and satisfying interpersonal relationships, their academic progress will be blocked” (p.
1). She continues, “Progress in compliance and emotional/impulse control are critical precursors
to academic achievement, as well as necessary companions to establishing social relations with
peers and adults” (Root, 1997, p. 1). Clarren (2004) identifies the social aspect of education as a
key weakness in students with FASD, stating “Students [with FASD] may have problems with
social communication skills and complex thinking, such as planning, predicting, organizing and
generalizing” (Clarren 2004). Moreover, Streissguth (1997) points out, “Students with FAS/FAE
may need to be taught things that other students simply learn through experience.” Weiner and
Morse (1994) also suggest that social skills present difficulties for children with FASD. They
suggest careful, repetitive, and concrete teaching of appropriate behavior, as well as role playing,
practice sessions, and clear, consistent, and immediate rewards and correction.
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General strategies for intervention design in this area
One approach that has not been examined is the use of video and computer-based
multimedia interventions for students with FASD. There is strong evidence to support the use of
a computer-based intervention for children with FASD, including promising research in the use
of video and computer-based interventions for children with autism.
Advantages of computer-based interventions for children with FASD
Smith and Meyen (2003) found that multimedia instructional tools are perfectly suited to
provide the individualized educational experiences for those students who require special
accommodations. They contend that the use of computers allows students with disabilities to
access educational investments already made for all students, making these interventions
possibly more cost effective in the long run. They state, “it is in the potential quality of online
instruction from a pedagogical perspective that makes online instruction a sound option.” One
example they list that is particularly applicable in trying to teach specific social skills is the
ability to model examples in a reliable, repeatable fashion with no variance.
Streissguth (1997) sums up the challenges facing educators when dealing with children
with FASD by pointing out that “they require more repetitions, less distracting environments,
more specialized techniques, and more encouragement”. A computer-based intervention is well
suited to meet these needs, as a computer is infinitely patient, willing and able to repeat the same
information as many times as the user needs without fatigue or frustration, offering the same
encouragement every time. Distractions can be limited by situating a computer in a quiet area.
Weiner and Morse (1994) suggest that, because children with FAS often have poor fine
motor skills, resulting in difficulty in writing, a computer could be used to remove the obstacle of
writing by hand. They also suggest that consistency in the environment is an important
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intervention strategy. Computers, again, are ideally suited to providing consistent, positive
feedback in a consistent environment.
To further strengthen the case for a computer-based intervention, studies of computerbased interventions for children with other disabilities, such as autism and ADHD, have shown
initial positive results for addressing a range of educational needs of these children. In one study
(Kimball, Kinney, Taylor, & Stromer, 2003), researchers found a positive effect for keeping
children with autism independently on task using computer-cued activity schedules. These
schedules were adaptations of visual schedules already being used by the children to help them
transition from one task to another. Children with FASD frequently use these visual schedules
for similar purposes. In another study Simpson, Langone, and Ayres (2004), found that by
combining video and computer based instruction, they were able to improve targeted social skills
of children with autism. Mechling and Gast (2003), through simulated multi-media instruction,
discovered students with autism were able to improve their ability to match words on a grocery
list with a grocery store aisle sign. In their study Ferguson, Myles, and Hagiwara (2005) found
that the use of a Personal Digital Assistant (PDA) helped decrease the reliance on adults for a
young man with Asperger Syndrome. Davies, Stock, and Wehmeyer (2003a) found that adults
with mental retardation made fewer errors operating a real ATM after completing a computer
based training course that simulated an ATM. In another study Davies, Stock, and Wehmeyer
(2003b) found that using a specially designed money management system improved the
management of personal checking accounts for individuals with mental retardation. Embregts
(2003) found that video and graphic feedback helped people with mental retardation increase
appropriate social behavior and decrease inappropriate social behavior. These studies will be
reviewed in more detail later.
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Technology based interventions for students with Autism
There have been several recent studies that have examined the affect of computer and
video based interventions on the social skills of children with Autism. Nikopoulos and Keenan
(2004) used a multiple baseline design across subjects to examine the effect that viewing videos
of peers modeling social initiation and reciprocal play behaviors had on three children with
autism. The children would watch a video of a peer and the experimenter engaging in social play
using one toy. For all three children, their social initiation and reciprocal play skills were
improved, with the results being maintained after one and three months.
Tom (2005) examined the effect that Videotaped Self Modeling (VSM) had on five
students with autism spectrum disorders with regards to a variety of behaviors, including social
initiations, tantrums, and aggression. They used a multiple baseline design across students and
behaviors in multiple sub-studies. They found that all of the students showed immediate and
significant improvement, and that the improvement was maintained over time.
Kimball, Kinney, Taylor, & Stromer (2003) found that PowerPoint based activity
schedules used by three students with autism were effective in keeping these students
independently engaged and on task for time periods of more than 30 minutes. Additionally, these
activity schedules were then used as a scaffold to help the children engage in social initiations
(asking a classmate to join them in an activity).
Charlop-Christy, Le, & Freeman (2000) compared the effectiveness of in vivo modeling,
when children watched live people modeling the targeted behavior, and video modeling, when
children watched video tapes of people modeling the targeted behavior, for teaching five children
with autism developmental skills. They used a multiple baseline design across children and
within children across tasks and modeling conditions. They found that the use of video modeling
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led to faster acquisition of the targeted behavior and to generalization of the behavior in four of
the five children (the other child required equal repetitions of both to acquire the targeted
behavior). The in vivo modeling did not lead to generalization of the behavior. The authors offer
two possible reasons for this. The first is the ability of the video modeling to zoom in on the
appropriate areas of focus for a given behavior, forcing the child to focus on the important cues,
whereas the in vivo modeling would allow the student to focus on irrelevant details of the
modeled behavior. Secondly, they propose that the video may have improved the students’
motivation, as many students with autism find television and video to be very engrossing.
Ferguson, Myles, and Hagiwara (2005) examined the effect of using a Personal Digital
Assistant (PDA) by an adolescent with Asperger Syndrome in an attempt to increase independent
behavior. The student, Kent, was heavily reliant on prompts from parents and teachers to
complete daily activities. Without these prompts, he would become distracted from his routine
and stop. They used a multi-baseline design across settings (morning tasks, school tasks, and
evening tasks) to test how effective the PDA was in improving his time management and task
completion skills. Kent improved his morning task completion from 0% to 47%, his evening
tasks from 0% to 33% and his school tasks from 63% to 87%. The authors indicated that the
results could, in part, be due to the novelty of the PDA. The device appealed to Kent and
therefore, may have eased his transition to the intervention. The data indicates that
generalizations across settings may have occurred. The authors also speculate that the PDA’s
ability to stimulate multiple senses through alarms and flashing lights, may have been useful in
prompting Kent to begin his tasks independently.
These studies show that computer based interventions, especially those that take
advantage of video, are effective interventions for children with autism, perhaps due in part to
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the strong visual memory of these children. This is a characteristic that children with autism have
in common with children with FASD, suggesting that these types of interventions may also be
effective for children with FASD.
In selecting social skills to target for a computer based intervention, I would like to draw
on the study by Simpson, Langone, and Ayres (2004) as the model for my study, attempting to
address their acknowledged shortcomings in the study and adapt the intervention to one that
would prove appropriate for children with FASD. Since their study was meant, in part, to
capitalize on the visual strengths that students with autism are reported to exhibit (Simpson et al.,
2004) and children with FASD tend to exhibit these same visual memory strengths, I feel it is an
appropriate model for me to use.
In their study, Simpson, Langone, and Ayres (2004) had children with autism watch
video embedded in an interactive computer program of their peers modeling appropriate social
behaviors. These behaviors were: sharing with others, complying with teacher directions, and
social greetings. They used a multi-probe design across four students enrolled in an urban
elementary classroom. Their description and screen captures of their intervention design
indicated a simplistic interface with few interaction choices. They found that all students showed
increases from baseline to treatment in their unprompted engagement in the social skills. One
students frequency of engagement accelerated during the baseline conditions, bringing into
question her results. Some limitations of this study, as identified by the authors, were lack of
control for observational learning, lack or threat to internal validity through the increasing
engagement trend of one student, and lack of large changes in student behavior due to prior
student ability. The lack of a post treatment probe, the relatively short timeline of the study, and
the lack of any qualitative data to give insight into possible correction of the treatment also were
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areas of concern. Nevertheless, using this as a model while attempting to correct the
shortcomings of the study will improve this research method and allow for a study of an
intervention for students with FASD. In selecting a targeted social behavior, I will focus on just
one of the targeted behaviors in this study, complying with teacher direction. This is an area that
has been identified as problematic for children with FASD.
Framework and strategies for intervention design
In order to create effective computer based interventions for students with FASD, it is
first important to identify strategies and best practices specific to students with FASD, and then
to incorporate these strategies and best practices into a framework that can then be used to guide
the design of future interventions. Streissguth (1997) sets some broad, overarching strategies,
stressing the importance of increased repetition, increased time to complete tasks, and
elimination of distractions. The following section will discuss specific strategies and how they
may be incorporated into a framework to guide development of a computer-based intervention.
Table 1 summarizes this framework.
Clarren (2004) stresses the need to create a quiet, calm, distraction free environment for
children with FASD. Since these children often have sensory integration issues, they easily
become over stimulated in environments with a lot of visual and auditory clutter that is common
in many educational settings. Kleinfeld and Wescott (1993) suggest using headphones for quiet
time, because students with FASD are often not able to block out background noise. This
suggestion translates easily into the design of a computer based intervention by simply equipping
the computer station that the children will be working at with headphones that sufficiently block
out external noise, allowing them to focus on the audio for the computer intervention. In
designing the interface for the computer based intervention, it will be important to keep the look
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and feel of the program clean, without a lot of visual clutter on the screen. The audio itself
should not have a lot of background music or distracting, unnecessary sounds. The visual focus
should be on the area of interaction. Navigation should be obvious, with limited number of
choices. Clarren (2004) suggests the use of study carrels to reduce social interactions and visual
distractions during study time. Again, placing the computer and monitor in a study carrel is an
easy adaptation to make. Clarren (2004) also suggests reducing visual distractions, such as
posters on the wall, decorations, mobiles hanging from the ceiling, among others.
Developing consistent routines that support learning is also an important consideration
when designing interventions for children with FASD. According to Clarren (2004), it can take
children with FASD two to six weeks to learn new routines. She also suggests that instruction
focus on essential information, that checklists be used for specific routines so that the students
can see and use them, and that pocket charts to show upcoming activities that include starting
times and other important information be. In using the checklist, she encourages the use of selftalk as students follow the checklist and suggests making routines short (three or less steps)
initially, gradually adding steps over time. The checklists and activities charts should feature
pictures as well as words to describe routines (Watson & Westby, 2003), taking advantage of the
strong visual memory skills of children with FASD, and the routines should be taught using
correction rather than consequences (Watson & Westby, 2003). Given these suggestions,
designing an appropriate computer-based intervention should focus on a routine that is fairly
short, is repeated every day over the course of more than six weeks, and that gradually adds steps
over time. Visual organizers on the screen, such as checklists and activity charts with pictures
and words to help the students through the routine, are also extremely important. Finally,
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feedback given to the students when they make mistakes should provide corrective actions they
can take rather than be punitive in nature.
Students with FASD often have difficulty learning and using time concepts (Clarren,
2004). For these students, it is important to provide concrete, visual representations of time when
they have to work within a specific time schedule. In designing a software intervention, it is
important to have a visual representation of the remaining time along with labels indicating the
remaining time in minutes in the activity. This will help them develop a better sense of time, as
well as learn to work more effectively within time limits.
Clarren (2004) identifies the importance of planning and pacing to help increase the
capacity to attend to and follow instruction in students with FASD. She gives several specific
strategies that are directly applicable to the design of good computer based interventions. First,
gradually move from one area of instruction to the next, reviewing past material. Next, preview
new concepts and vocabulary to start each learning activity and review the important concepts at
the end of a lesson. Allow students time to process instructions. Finally, make directions simple,
specific, and concrete. These steps will help students transition from one topic to another more
easily.
Watson and Westby (2003) also identify the need for repetition, especially when it comes
to role-playing to teach social skills. Since children with FASD tend to have difficulty problem
solving, they should be given choices and offered coaching or scaffolding in these situations.
This will allow them to develop problem solving skills in a non-stressful, non threatening
environment.
Interventions for Children with FASD
Summary and conclusions
By using the strategies outlined above, it will be possible to design computer-based
interventions that are tailored to the specific needs of children with FASD. I hope that this will
not only prove useful for this study, but also lay the groundwork for additional studies and the
design of effective computer-based interventions for children with FASD.
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Interventions for Children with FASD
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References
Charlop-Christy, M. H., Le, L., & Freeman, K. A. (2000). A Comparison of Video Modeling
with In Vivo Modeling for Teaching Children with Autism. Journal of Autism and
Developmental Disorders, 30(6), 537-552.
Davies, D. K., Stock, S. E., & Wehmeyer, M. L. (2003a). Application of Computer Simulation to
Teach ATM Access to Individuals with Intellectual Disabilities. Education and Training
in Developmental Disabilities, 38(4), 451-456.
Davies, D. K., Stock, S. E., & Wehmeyer, M. L. (2003b). Utilization of Computer Technology
To Facilitate Money Management by Individuals with Mental Retardation. Education
and Training in Mental Retardation and Developmental Disabilities, 38(1), 106-112.
Embregts, P. J. C. M. (2003). Using Self-Management, Video Feedback, and Graphic Feedback
to Improve Social Behavior of Youth with Mild Mental Retardation. Education and
Training in Developmental Disabilities, 38(3), 283-295.
Ferguson, H., Myles, B. S., & Hagiwara, T. (2005). Using a Personal Digital Assistant to
Enhance the Independence of an Adolescent with Asperger Syndrome. Education and
Training in Developmental Disabilities, 40(1), 60-67.
Henriksson, L. (2004). Fetal alcohol spectrum disorders and memory University of Clagary,
Calgary, Alberta.
Kimball, J. W., Kinney, E. M., Taylor, B. A., & Stromer, R. (2003). Lights, Camera, Action!
Using Engaging Computer-Cued Activity Schedules. TEACHING Exceptional Children,
36(1), 40-45.
Kleinfeld, J. (2000). Fantastic Antone Grows Up: Adolescents and Adults with Fetal Alcohol
Syndrome. Fairbanks, AK: University of Alaska Press.
Interventions for Children with FASD
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Kleinfeld, J., & Wescott, S. (1993). Fantastic Antone Succeeds! Experiences in Educating
Children with Fetal Alcohol Syndrome. Fairbanks, AK: University of Alaska Press.
Malbin, D. B. (1999). Fetal Alcohol Syndrome/Fetal Alcohol Effects: Trying Differently Rather
Than Harder. Portland, OR: Fetal Alcohol Syndrom Consultation, Education and
Training Services (FACETS), Inc.
Mechling, L. C., & Gast, D. L. (2003). Multi-Media Instruction To Teach Grocery Word
Associations and Store Location: A Study of Generalization. Education and Training in
Mental Retardation and Developmental Disabilities, 38(1), 62-76.
Nikopoulos, C. K., & Keenan, M. (2004). Effects of Video Modeling on Social Initiations by
Children with Autism. Journal of Applied Behavior Analysis, 37(1), 93.
Peterson, D. (2007). Learning Characteristics of Children with Fetal Alcohol Spectrum
Disorders. Unpublished Research Paper. University of Minnesota.
Root, P. (1997). Effective Teaching for FAS & FAE Children.
Simpson, A., Langone, J., & Ayres, K. M. (2004). Embedded Video and Computer Based
Instruction to Improve Social Skills for Students with Autism. Education and Training in
Developmental Disabilities, 39(3), 240-252.
Smith, S. J., & Meyen, E. L. (2003). Applications of Online Instruction: An Overview for
Teachers, Students with Mild Disabilities, and Their Parents. Focus on Exceptional
Children, 35(6), 1-15.
Streissguth, A. (1997). Fetal Alcohol Syndrome: A Guide for Families and Communities.
Baltimore, MD: Paul H. Brooks Publishing Co., Inc.
Interventions for Children with FASD
Tom, B. (2005). Video Self-Modeling Applications With Students With Autism Spectrum
Disorder in a Small Private School Setting. Focus on Autism and Other Developmental
Disabilities.
Weiner, L., & Morse, B. A. (1994). Intervention and the child with FAS. Alcohol Health &
Research World, 18(1), 67 - 73.
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Table 1 - Framework for the design of computer-based interventions for students with FASD
Principle
Purpose
Area of implementation
Use headphones.
Reduces outside audio
Hardware Setup and
distraction to allow the student Configuration
to focus on instruction.
Place Computer In Study
Reduces visual and social
Hardware Setup and
Carrel.
distraction to allow the student Configuration
to focus on instruction.
No Background Music.
Reduces audio distraction to
Software Design
allow the student to focus on
instruction.
Minimalist design, with little
Reduces visual distraction to
Graphic Design, Software
or no visual clutter, clean
allow the student to focus on
Design
graphics, etc.
instruction.
Limited number of interaction
Reduces visual distraction and
Graphic Design, Interface
and navigation buttons.
the feeling of being
Design, Software Design
overwhelmed with choices,
allowing student to focus on
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instruction.
Use checklists and activity
Eases transition from step to
Graphic Design, Interface
charts that contain pictures
step and helps student develop
Design, Instructional Design
and words for navigating
routines.
through the software.
Use short, one to three step
Allows student to build a
Instructional Design, Software
activities, gradually increasing
routine, and then add
Design
the number of steps over the
complexity slowly, over time.
course of six or more weeks.
Give feedback in positive,
Encourages students, gives
corrective terms, rather than
them direction, discourages
negative or punitive terms.
the development of negative
Instructional Design
feelings.
Use visual representation of
Helps students develop a sense Instructional Design, Graphic
time, with minutes remaining
of time, and keeps them aware
labeled appropriately.
of how much time is
Design, Interface Design
remaining for their activity.
Review past material before
Helps students transition from
Instructional Design
Interventions for Children with FASD
moving to new material.
one topic to the next.
Preview new concepts and
Helps students transition from
vocabulary at the beginning of
one topic to the next.
20
Instructional Design
each lesson.
Allow students time to process Helps students transition from
material just covered.
one topic to the next.
Make directions simple,
Helps students be clear on
specific, and concrete.
what expectations are.
Provide coaching or
Helps students build on weak
scaffolding to assist in
problem-solving skills.
Instructional Design
Instructional Design
Instructional Design
decision making.
Provide repeated opportunities
Provides the repetition
to practice the targeted skill or
necessary to help overcome
behavior.
short term memory deficits.
Instructional Design